It wasn't long after Sept. 11 that the public discussion turned to the prospect of even worse attacks. The possibility of biological warfare got in our heads, and, for good reason, it's proving hard to dislocate: Even a moderately successful biological attack could kill millions -- and in many cases, rather slowly. Four out of every five Americans believe another attack within the U.S. within a year is either "very likely" or "somewhat likely," according to a TIME/CNN poll, yet how we as individuals, and as a nation, should best proceed remains murky.
We knew things would be different; we even knew there could be more terrorism, but it took a while before we pieced together the grim possibilities. Suddenly, a raft of germ warfare threats lurks in every paper bag, in every cooler, in every tractor trailer that passes. Some talk of leaving -- Isn't this what Jews should have done when they had the chance in Germany? Are we staying beside the volcano even after it rumbles? -- but a good biological weapon will eventually find you. So for now, we stay near the TV, watch for signs.
No hard evidence connects Osama bin Laden to biological weapons, but the Washington Times quoted U.S. intelligence officials on Sept. 26 saying that the Russian mafia has likely been supplying al-Qaida with components for these weapons, and for chemical and nuclear weapons as well. And two years ago, a former Afghan warrior who had trained with bin Laden told the Associated Press that "Osama has dozens of camps. They train on antiaircraft guns, explosives, chemical and biological weapons."
Nervous or not, most of us believe we're safe. Given the mounting evidence of an imminent attack, it's hard to imagine why we feel this way. Consider the following:
There's a lot we don't know, but we do know the following: Our adversaries are serious, they're willing to die and they have the money to finance a significant operation. We know that reports say bin Laden has been training his followers in biological and chemical warfare, that "hunting down" every terrorist is impossible and that men connected to al-Qaida have looked into acquiring crop-dusting planes and licenses for driving hazardous-materials trucks. We know that bin Laden has said he wants to destroy the United States -- quite different from simply sending us a message or effecting a policy change or two.
Read some of the preparedness recommendations from within the medical and research communities -- you can almost hear the authors sighing. A recent World Health Organization report claims that a biological attack could well be "on such a scale or of such a nature as to be beyond the capability of the health-care system to cope." Preparing for such an outbreak at this point is a terrific idea, but it's also a little like dabbing sunscreen on skin cancer. Our level of readiness would be laughable if it weren't so cryable. Even if an executive order forced the pharmaceutical industry, state and local hospitals, FEMA and the CDC to devote every single resource to prevention and response programs, it would be years before we approached basic preparedness. Even then, some argue, basic preparedness could mean acknowledging that preparedness is a myth, and a whole new approach to geopolitics is in order.
On Sept. 16, the Washington Post published an extraordinary report detailing the stunning response failures the city of Washington witnessed in the immediate aftermath of the attacks on the World Trade Center and the Pentagon.
The department could not tell its 3,800 officers to go to Stage 3 or Level 5 of response, Gainer said, because it had no stages or levels. There was no list of streets to close to thwart threats, or to make one-way to ease evacuation. Nor were there guidelines spelling out which officers should go where, which buildings must be shut or which emergency vehicles ought to be marshaled. The department had considered having such a plan, Gainer said, "but it was never in the center of my desk, and it was never finalized."
It's not just city gridlock. A recent survey of 186 hospitals in four Northwestern states found that 80 percent had no plans for a biological or chemical attack. The survey, published in the American Journal of Public Health, revealed that only 6 percent had taken the minimum recommended preparations for a nerve gas attack like the one Tokyo experienced in 1995.
Randy Larsen, director of the Anser Institute for Homeland Security and former chairman of the National War College in Washington, has spent the last seven years assessing our exposure to bioterrorism. Public health, he says, constitutes "a major part of national security in the 21st century." Meanwhile, we're living in the 20th -- follow the lack of money, he says: "Hospitals are currently 30 percent in the red, and 50 percent of teaching facilities are in the red." And Larsen knows exactly what hospital administrators say when someone proposes upgrading facilities to handle germ warfare: "Are you crazy? How does that help my bottom line?"
"We have allowed our healthcare industry to atrophy," Larsen says. "It's in horrible condition for the wealthy nation that we are."
Unbelievably, Health and Human Services Secretary Tommy Thompson told "60 Minutes" on Sunday that the U.S. is "prepared to take care of any contingency, any consequence that develops from any kind of bio-terrorism attack." Thompson alluded to the eight staging areas throughout the country that contain vaccines, antibiotics, gas masks, ventilators and other supplies. These packages can be shipped out to a disaster site within hours.
What Thompson doesn't say is that this is a shot in the dark. According to the plan, the supplies will be shipped as soon as a city or region recognizes that an attack has occurred. By and large, recognition means it's too late. With anthrax, the appearance of symptoms marks the point at which antibiotics are useless. As for the vaccine, it's been well publicized that we don't have enough. In fact, we're not even sure it would work: The anthrax released could be a new strain that's resistant to vaccination. A report appeared Monday claiming researchers at Harvard Medical School "had identified a gene found in mice that in some forms made mice resistant to anthrax," according to Reuters. While this development takes us closer to finding an antidote, it will be years before we see anything definitive.
And this is only anthrax. If the terrorists infected us with smallpox, for instance, the supply packages wouldn't be worth their postage. Unlike anthrax, smallpox is extremely contagious, and no antiviral agents have proven effective in treating it. By the time it was spotted -- presumably after the 12- to 14-day incubation period -- it would likely be everywhere. Historically, health officials have assumed that an infected person will infect roughly 15 others per day, until he or she has been isolated. If just two terrorists gave themselves smallpox and spent a day in, say, LaGuardia airport, 450 travelers could have smallpox by dinner time. Five days later, by this formula, almost 350 million could have it. And it would still be another week before anyone knew.
Even a clinical description of smallpox is painful to read. According to the Johns Hopkins University Center for Civilian Biodefense Studies,
After the incubation period, the patient experiences high fever, malaise, and prostration with headache and backache. Severe abdominal pain and delirium are sometimes present. A mascopapular rash then appears, first on the mucosa of the mouth and pharynx, face and forearms, spreading to the trunk and legs. Within one or two days, the rash becomes vesicular and later pustular. The pustules are characteristically round, tense and deeply embedded in the dermis; crusts begin to form about the eighth or ninth day. When the scabs separate, pigment-free skin remains, and eventually pitted scars form.
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The media has focused recently on two indices of panic: the leading anthrax antibiotic and gas masks. Not long after last month's attacks, word spread that the antibiotic Ciprofloxacin -- also a fairly common treatment for urinary tract infections -- was already impossible to find, and that obtaining even a cheap gas mask suddenly meant spending hundreds on eBay.
The official response, in turn, has been bizarre and convoluted. In the "60 Minutes" interview, Thompson called gas masks unnecessary, adding: "How would you be able to utilize it? Are you going to have a gas mask with you 24 hours a day?"
Thompson stumbled here into a strange new logic that has emerged in recent conversations about bio-terror. Rather than explain why we shouldn't panic, we explain that panicking isn't useful. Ask people why they're not worried and they give the same shrugging reply: "Worrying doesn't help." This is Tommy Thompson logic. Worrying may not help, but what does that have to do with anything, and when did we become so pragmatic?
Is the truth nothing more than a collective failure of imagination? Are we incapable of picturing hundreds of citizens suffering an agonizing death in our own streets? We continue to employ lightning storm reasoning here: If the bolts have your number, they have your number. But germ warfare introduces a radical new element to the existential calculus of weighing risks: instead of lightning's quick death, we'd suffer prolonged, excruciating, disfiguring pain. Is it still meaningful to say worrying doesn't help?
Listen to the professional calmers, and at the heart of their reassurance you'll hear the same rhetorical omission over and over: Everyone says a ninth-grade biology student could make anthrax in his bathtub, they say, but it's not that easy. Well, we didn't ask about ninth-grade biology students. We're interested in what a wealthy, organized and well-connected terrorist is capable of.
As to how to combat such a threat, our options are disturbingly limited. Prevention is possible, desirable and, according to many experts, extremely undependable, if not downright impossible. Relying on quickly getting an antidote to the infected is rife with logistical problems. And, given the incubation period -- we could all have anthrax, smallpox, botulism, tularemia or the plague right now, actually -- any decision to flee presupposes that a biological attack hasn't already happened; hardly airtight reasoning if we've already accepted the premise that attack is imminent.
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Leslie Gelb, president of the Council on Foreign Relations, has commented on the media's reluctance to pick up the biowarfare story until recently. He recalls a startling opinion piece in the Washington Post written in 1999 by then-Defense Secretary William Cohen. "In the past year, dozens of threats to use chemical or biological weapons in the United States have turned out to be hoaxes," Cohen wrote. "Someday, one will be real."
"I watched carefully to see if anyone followed up on this," Gelb told the New Yorker recently. "But none of the television networks and none of the elite press even mentioned it ... I was astonished."
Now, nearly a year into the 21st century, America has begun an overhaul of its imaginative capabilities, much as plague-era Europe had to do six centuries ago. The sphere of conceivable terror now extends beyond shark attacks and occasional stray bullets. We go to baseball games, airports and subway stations with a vast and awful new narrative in our heads. Dimly, we can picture the chain of failed intelligence, the harmless-looking cooler at the football game, the cough after breakfast two weeks later, the frantic phone calls, the blocked roads, the clutching at the chest and finally a few lurching steps stumbled down the block.
Much has been said about the new American landscape, or at least our new lens. We grab around for a way to understand what's happening, and surely someone will eventually write a book about how this period was our Judgment Day: Suddenly, after all, we find ourselves facing an uncertain fate, at the hands of a mysterious and wrathful entity. As we wait for something terrible, we look around us for a glimpse of where we went wrong, of which sins couldn't be forgiven. Was it McDonald's? All those terrible movies? Greed? Was it the way we sometimes lose sight of what's meaningful? Or did we just send too many women to college?
We wait. We wait for our government to announce victory, or for medicine to catch up with evil, or for the first scratches of a cough in the back of the throat. Gas masks and tickets to Alaska -- these feel neither realistic nor effectual. Long ago, someone fired a bullet in the air -- the advent of biological weapons -- and now we must shuffle around nervously wondering where it will land.
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